Pre-Operative Assessment Hernia repair Information for patients

Transcription

1 Pre-Operative Assessment Hernia repair Information for patients

2 What is a hernia? A hernia occurs when part of the bowel sticks out through a weak area in the muscles of your abdomen - causing a bulge or lump. You can feel a soft lump under the skin. A hernia is sometimes described as a rupture. A hernia can be uncomfortable and feel tender, especially when bending or lifting. It may make it difficult for you to do normal activities, like shopping or having sex. Some people can push their hernia back in, but it s likely to come out again. Surgery is the only way to repair a hernia. What causes a hernia? A hernia can be caused by: Congenital weakness (present at birth) Age-related weakness in the abdominal wall Strenuous activity or excessive strain from heavy lifting Pregnancy Previous surgery involving the abdominal wall Can hernias be prevented? Probably not. Hernias are very common (approximately 120,000 per year in the United Kingdom) and are experienced by people with both active and inactive lifestyles. Different types of hernia An inguinal (groin) hernia This is the most common type of hernia - affecting approximately 2-3% of the population. It is much more Information for patients 2

3 common in men than in women. The hernia is seen as a lump in the groin which may disappear on lying flat or which may be pushed back, only to reappear with standing, coughing or straining. It can cause discomfort and tends to increase in size with time. Occasionally the hernia can get stuck, or be very painful - when urgent surgery might be necessary. This is sometimes called a strangulated hernia. A femoral hernia This is more common in women than men. It is usually seen as a lump lower in the groin, near the skin crease towards the top of the thigh. It is more likely to become stuck than an inguinal hernia and should be repaired promptly by surgery. An epigastric hernia This is caused by weakening of the muscles in the central, upper abdomen, causing a lump or bulge to appear anywhere between the breastbone and the navel. The lump can be quite small or extremely large and tends to be more common in middle age. It is best repaired by surgery. An umbilical hernia This occurs at, or near the navel. It is very common in children. In adults it is more common in women, often in those who have had children. An incisional hernia This may occur at any site where an operation has been performed previously. The scar represents a weakened area, which, over time, may allow the intestines underneath to bulge through. Surgical repair is often necessary. Strangulated hernia Sometimes a hernia can become strangulated trapped in the gap it has come through. This can cut off the blood supply to this part of the intestine, which causes an acute blockage. This may lead to perforation of the bowel, which then allows bacteria to escape into the abdomen and cause Information for patients 3

4 a serious infection or inflammation called peritonitis. This is a potentially life-threatening condition which requires emergency surgery. The main symptom is usually severe pain over the hernia bulge, often with reddening of the overlying skin. What is the treatment for hernia? Generally, a hernia that can be pushed back easily, or flattened, is not an immediate danger to your health, although it can be uncomfortable. An untreated hernia will not get better on its own. If left untreated, it is likely to continue to increase in size over time and become more painful. Surgery is the only way to repair a hernia. How will surgery help? Surgery will: Get rid of the bulge in your groin Make you more comfortable and lessen your pain Allow you to get back to normal activities and work Prevent a strangulated hernia (see above) But, hernias can come back. What are the alternatives? Surgery is the only way to repair a hernia. What is involved in hernia repair surgery? The operation is usually performed as open surgery but it can be done as keyhole surgery. Both open and keyhole surgery take Information for patients 4

5 about 30 minutes. A hernia repair is usually carried out as a day case you don t need to stay in hospital overnight. Open surgery This is performed through a cut about 10 cm (4 ) long in the groin. The hernia is pushed back through the gap into its proper place inside the abdomen. The weakness is usually covered by a piece of sterile mesh that is stitched in place. The abdomen is then closed with further stitches. Keyhole surgery - Total Extra-Peritoneal (TEP) repair In this type of operation the surgeon uses a camera to see inside your groin instead of opening it up. The surgeon makes a small cut near the belly button and inserts the camera behind the abdominal muscle and in front of the peritoneum (the membrane that lines the abdominal walls). The abdominal cavity is not entered. This is now the preferred method used by Surgeons at the Oxford Radcliffe Hospitals doing keyhole surgery for hernia. It is used for recurrent hernias, bilateral hernia and in selected first time cases. The advantage of this type of surgery is significantly less post operative pain and faster recovery, but a slightly increased risk of the hernia coming back. (In laparoscopic surgery the abdominal cavity is entered. This involves different risks and is not used here.) What happens to the mesh in a mesh repair? The mesh is surgically stitched in place and as the stitches dissolve, tissue grows into and around the mesh to keep it in place. The mesh does not dissolve. There is very small risk (1 in 2,000-3,000 people) of the body rejecting the mesh - it would then need to be removed. Anaesthesia A general anaesthetic is recommended for this operation. Few people now experience any nausea or sickness following this Information for patients 5

6 type of anaesthesia. However, if a local anaesthetic is preferred, the area to be operated on can be completely numbed for the duration of the operation. Patients who have a local anaesthetic are usually also given a sedative to help them relax. What are the risks of hernia repair surgery? There is a risk of complications and side effects. Your surgeon will be able to explain how these risks apply to you. Temporary bruising, swelling or scarring at the site of surgery. This is very common and will only last a few days. Although the scarring will fade an incision line will always remain. In men, swollen testicles and bruising are common for a few days after the operation. Temporary difficulty in passing urine this can last for hours, but it is uncommon. Side effects of the anaesthetic - such as feeling sick. Serious problems are rare. Infection - You may get an infection deep inside your groin or in the wound on your skin, but this is very rare. Bleeding you can bleed heavily under the skin after the operation. If the blood builds up and clots, your groin will swell and feel tender. This will give you a big bruise called a haematoma. Sometimes it will stop by itself, but sometimes an operation is needed. Damage to blood vessels or other organs this is rare. Damage to nerves causing numbness in the groin area. Feeling may come back, but it can last for months or years. About 11 in 100 people have numbness in their groin area a year after the operation. The risk is less with keyhole surgery. Risk of the hernia reoccurring between 3 and 9 hernias in 100 come back. Information for patients 6

7 Preparation for your operation Do not smoke on the morning of surgery. (If possible, try to give up smoking altogether, or to cut down.) The hospital has a no smoking policy so you will be unable to smoke before or after your operation. Do not eat any food, chew gum or suck sweets after midnight the night before your operation. Drink plenty of fluids, preferably water, the day before your operation to help keep your body hydrated. You can drink clear fluids throughout the night and up to 6 a.m. (e.g. water, black coffee or tea, but NOT juice or fizzy drinks). Take your regular medication as usual unless otherwise instructed. (Please bring all your medication in with you in its original containers.) Don t worry about shaving the surgical site this will be done in theatre. Please leave jewellery and valuables at home. A wedding band can be left on and will be taped before going to theatre. Please remove any make-up and nail varnish (from fingernails and toenails). Bring with you: Dressing gown and slippers and overnight bag. All your medication - in the original containers. Something to pass the time while you are waiting for your operation - such as a book. Information for patients 7

8 Arriving at hospital The reception staff in Theatre Direct Admissions or the Day Surgery Unit will book you in, check your personal details and put your identification wristband on. One of the nurses will then record your blood pressure, pulse and temperature and ask you some questions for the operation checklist to ensure you are correctly prepared for your operation. Staff will explain what will happen throughout the day. The surgeon will see you beforehand to talk to you about your operation and to answer any remaining questions you may have. The surgeon will ask you to sign a consent form which will describe the risk and benefits of the operation. The operation site will be marked with a marker pen. The anaesthetist will also see you before the operation and talk to you about the anaesthetic. If you have any questions or concerns, this is the time to ask. Going to the operating theatre You may have to wait before your operation, which could be anytime between am and pm. The reception staff will tell you when to put on a gown and possibly some support stockings (to help prevent blood clots). A nurse may then give you your pre-medication if it has been prescribed by the anaesthetist. The anaesthetic nurse will escort you to the anaesthetic room where you will be asked to lie down on a trolley. They will go through a safety checklist with you. Some sticky pads will be attached to your chest and connected to a heart monitor and a blood pressure cuff will be put on your arm. The anaesthetist will then put a needle into a vein in the back of your hand to give you the anaesthetic. When you are asleep a tube will be put into your windpipe to aid your breathing. This Information for patients 8

9 will be taken out before you wake up. (This may leave you with a sore throat after surgery but drinking water little and often will help relieve this.) Recovery You will wake up in the recovery area. You will have an oxygen mask on your face until your oxygen levels are back to normal. The recovery nurse will check your blood pressure and wound site regularly. When you are comfortable and your blood pressure is stable a nurse will collect you and take you back to the ward. Back on the ward You will be made comfortable in your bed or on a reclining chair and advised to rest. Your blood pressure, pulse, temperature and wound site will be checked. You will gradually be allowed to drink water. If you are able to tolerate good amounts and don t feel sick, then you will be able to have a hot drink and something light to eat. You may have an intravenous drip in your arm which will be removed when you are drinking enough fluids. When you get out of bed for the first time a nurse will need to be with you in case you feel light headed or dizzy. A local anaesthetic may be injected into the wound to make you feel more comfortable. If you have any pain, please tell your nurse so that your pain relief medication can be adjusted. You will need to stay on the ward for a minimum of 2 hours after your operation before you can go home. Information for patients 9

10 Discharge instructions It is essential that you have a responsible and able adult to take you home and to stay with you overnight and the next day. Do not drink alcohol, operate any machinery or sign any legal documents for 48 hours after your general anaesthetic. You should not drive a car for 7-10 days after your operation, and then only if you feel confident about performing an emergency stop without discomfort. After your operation GP appointment Please make an appointment to see your GP about 2 weeks after the operation. If you are worried that the wound is showing any signs of infection i.e. if it is swollen, red, painful, hot, or if you are feverish, you should make an appointment to see your GP straight away. Pain relief We will give you painkillers to take home with you. We recommend that you take these at regular intervals for the first few days in order to get maximum pain relief. Most people continue to experience some discomfort for a few weeks after the operation, but this will gradually settle. If you are about to cough or sneeze, it will help if you put light supportive pressure on your wound site with your hand or with a small pillow. Whether recovering from open or keyhole surgery you will need to take it easy for the first 2 or 3 days. Stitches You will probably have dissolvable stitches. If you have stitches that need to be removed then your GP practice nurse can do this for you. You should make an appointment to have this done 7-10 days after your operation. Information for patients 10

11 Wound care The wound should be kept dry for the first 2 days. After 2 days you can have a shower. The damp dressings need to be removed after showering in order to reduce the risk of infection. Pat the wound dry with a clean towel. You may use a hairdryer to dry it further if you wish. Do not use scented soap or talcum powder near the wound. Resuming normal activity and returning to work It is important you do not say in bed. Gentle exercise such as walking is beneficial. Do not lift any object that weighs more than 5 lbs in weight, or do anything that involves strenuous pushing, pulling or stretching, for 4-6 weeks. The length of time you take off work depends on the job you do. However, 2-3 weeks for light, desk-based work, and 4-6 weeks for heavier, manual work is usual. Sexual activity can be resumed as soon as you are comfortable enough. It is advisable to have a high fibre diet to avoid constipation as this will help reduce the strain on the site of the operation. Driving You may drive again when you can confidently perform an emergency stop, without worrying about your hernia repair. This is usually between 7 and 14 days after the operation. Further information If you have any questions or need any further advice or information, please telephone Pre-operative Assessment at: John Radcliffe: (01865) between 8am 5pm or Horton Hospital: (01295) between 8.30am 4.30pm Information for patients 11

12 References Burkitt H.G. & Quick C.R.G. (2002) Essential Surgery: Problems, Diagnosis and Management. Churchill Livingstone London Phillips W. & Goldman M. The British Hernia Centre (1998). The preferred method. (Clinical evidence for patients from the BMJ.) If you need an interpreter or need a document in another language, large print, Braille or audio version, please call or PALSJR@orh.nhs.uk Cheryl Booth, Pre-op Assessment Manager Greg Sadler, Consultant Surgeon Hernia Repair Version 2, April 2010 Review date April 2013 OMI 1836